Loma Linda University Behavioral Medicine Center (BMC)

All Charges

Charge

Type

Setting

Price

HC SOM BORIC ACID

Facility

$85.00

Service Code	CPT 83018
Hospital Charge Code	900911050
Hospital Revenue Code	301
Min. Negotiated Rate	$46.75
Max. Negotiated Rate	$68.00
Rate for Payer: Cash Price	$85.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$68.00
Rate for Payer: Health Smart Auto/Commercial	$51.00
Rate for Payer: LLUH Dept of Risk Management WC	$46.75
Rate for Payer: Multiplan Commercial	$63.75

HC SOM BORON

Facility

$73.00

Service Code	CPT 83018
Hospital Charge Code	900914503
Hospital Revenue Code	301
Min. Negotiated Rate	$40.15
Max. Negotiated Rate	$58.40
Rate for Payer: Cash Price	$73.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$58.40
Rate for Payer: Health Smart Auto/Commercial	$43.80
Rate for Payer: LLUH Dept of Risk Management WC	$40.15
Rate for Payer: Multiplan Commercial	$54.75

HC SOM BORON

Facility

$73.00

Service Code	CPT 83018
Hospital Charge Code	900914503
Hospital Revenue Code	301
Min. Negotiated Rate	$21.96
Max. Negotiated Rate	$58.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$43.80
Rate for Payer: Aetna of CA Government/Medicare	$43.80
Rate for Payer: Cash Price	$73.00
Rate for Payer: Cash Price	$73.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$58.40
Rate for Payer: Health Smart Auto/Commercial	$43.80
Rate for Payer: Intervalley Health Plan Commercial	$21.96
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$43.80
Rate for Payer: LLUH Dept of Risk Management WC	$40.15
Rate for Payer: Multiplan Commercial	$54.75

HC SOM BORRELIA BURGDORFERI PCR PROBE

Facility

$26.66

Service Code	CPT 87476
Hospital Charge Code	900912513
Hospital Revenue Code	306
Min. Negotiated Rate	$14.66
Max. Negotiated Rate	$35.09
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$16.00
Rate for Payer: Aetna of CA Government/Medicare	$16.00
Rate for Payer: Cash Price	$26.66
Rate for Payer: Cash Price	$26.66
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$21.33
Rate for Payer: Health Smart Auto/Commercial	$16.00
Rate for Payer: Intervalley Health Plan Commercial	$35.09
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$16.00
Rate for Payer: LLUH Dept of Risk Management WC	$14.66
Rate for Payer: Multiplan Commercial	$20.00

HC SOM BORRELIA BURGDORFERI PCR PROBE

Facility

$26.66

Service Code	CPT 87476
Hospital Charge Code	900912513
Hospital Revenue Code	306
Min. Negotiated Rate	$14.66
Max. Negotiated Rate	$21.33
Rate for Payer: Cash Price	$26.66
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$21.33
Rate for Payer: Health Smart Auto/Commercial	$16.00
Rate for Payer: LLUH Dept of Risk Management WC	$14.66
Rate for Payer: Multiplan Commercial	$20.00

HC SOM BRUCELLA AB CONFIRMATION

Facility

$116.41

Service Code	CPT 86622
Hospital Charge Code	900912841
Hospital Revenue Code	302
Min. Negotiated Rate	$64.03
Max. Negotiated Rate	$93.13
Rate for Payer: Cash Price	$116.41
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$93.13
Rate for Payer: Health Smart Auto/Commercial	$69.85
Rate for Payer: LLUH Dept of Risk Management WC	$64.03
Rate for Payer: Multiplan Commercial	$87.31

HC SOM BRUCELLA AB CONFIRMATION

Facility

$116.41

Service Code	CPT 86622
Hospital Charge Code	900912841
Hospital Revenue Code	302
Min. Negotiated Rate	$8.93
Max. Negotiated Rate	$93.13
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$69.85
Rate for Payer: Aetna of CA Government/Medicare	$69.85
Rate for Payer: Cash Price	$116.41
Rate for Payer: Cash Price	$116.41
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$93.13
Rate for Payer: Health Smart Auto/Commercial	$69.85
Rate for Payer: Intervalley Health Plan Commercial	$8.93
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$69.85
Rate for Payer: LLUH Dept of Risk Management WC	$64.03
Rate for Payer: Multiplan Commercial	$87.31

HC SOM BRUCELLA AB IGG

Facility

$20.74

Service Code	CPT 86622
Hospital Charge Code	900911628
Hospital Revenue Code	302
Min. Negotiated Rate	$11.41
Max. Negotiated Rate	$16.59
Rate for Payer: Cash Price	$20.74
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$16.59
Rate for Payer: Health Smart Auto/Commercial	$12.44
Rate for Payer: LLUH Dept of Risk Management WC	$11.41
Rate for Payer: Multiplan Commercial	$15.55

HC SOM BRUCELLA AB IGG

Facility

$20.74

Service Code	CPT 86622
Hospital Charge Code	900911628
Hospital Revenue Code	302
Min. Negotiated Rate	$8.93
Max. Negotiated Rate	$16.59
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.44
Rate for Payer: Aetna of CA Government/Medicare	$12.44
Rate for Payer: Cash Price	$20.74
Rate for Payer: Cash Price	$20.74
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$16.59
Rate for Payer: Health Smart Auto/Commercial	$12.44
Rate for Payer: Intervalley Health Plan Commercial	$8.93
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.44
Rate for Payer: LLUH Dept of Risk Management WC	$11.41
Rate for Payer: Multiplan Commercial	$15.55

HC SOM BRUCELLA AB IGM

Facility

$20.74

Service Code	CPT 86622
Hospital Charge Code	900912667
Hospital Revenue Code	302
Min. Negotiated Rate	$8.93
Max. Negotiated Rate	$16.59
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$12.44
Rate for Payer: Aetna of CA Government/Medicare	$12.44
Rate for Payer: Cash Price	$20.74
Rate for Payer: Cash Price	$20.74
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$16.59
Rate for Payer: Health Smart Auto/Commercial	$12.44
Rate for Payer: Intervalley Health Plan Commercial	$8.93
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$12.44
Rate for Payer: LLUH Dept of Risk Management WC	$11.41
Rate for Payer: Multiplan Commercial	$15.55

HC SOM BRUCELLA AB IGM

Facility

$20.74

Service Code	CPT 86622
Hospital Charge Code	900912667
Hospital Revenue Code	302
Min. Negotiated Rate	$11.41
Max. Negotiated Rate	$16.59
Rate for Payer: Cash Price	$20.74
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$16.59
Rate for Payer: Health Smart Auto/Commercial	$12.44
Rate for Payer: LLUH Dept of Risk Management WC	$11.41
Rate for Payer: Multiplan Commercial	$15.55

HC SOM C-1 ESTERASE INHIBITOR ACTIVIT

Facility

$18.00

Service Code	CPT 83883
Hospital Charge Code	900911175
Hospital Revenue Code	301
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$14.40
Rate for Payer: Cash Price	$18.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$14.40
Rate for Payer: Health Smart Auto/Commercial	$10.80
Rate for Payer: LLUH Dept of Risk Management WC	$9.90
Rate for Payer: Multiplan Commercial	$13.50

HC SOM C-1 ESTERASE INHIBITOR ACTIVIT

Facility

$18.00

Service Code	CPT 83883
Hospital Charge Code	900911175
Hospital Revenue Code	301
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$10.80
Rate for Payer: Aetna of CA Government/Medicare	$10.80
Rate for Payer: Cash Price	$18.00
Rate for Payer: Cash Price	$18.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$14.40
Rate for Payer: Health Smart Auto/Commercial	$10.80
Rate for Payer: Intervalley Health Plan Commercial	$13.60
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$10.80
Rate for Payer: LLUH Dept of Risk Management WC	$9.90
Rate for Payer: Multiplan Commercial	$13.50

HC SOM C1 EXTERASE INHIBITOR FUNCTION

Facility

$30.00

Service Code	CPT 83520
Hospital Charge Code	900912844
Hospital Revenue Code	302
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$24.00
Rate for Payer: Cash Price	$30.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$24.00
Rate for Payer: Health Smart Auto/Commercial	$18.00
Rate for Payer: LLUH Dept of Risk Management WC	$16.50
Rate for Payer: Multiplan Commercial	$22.50

HC SOM C1 EXTERASE INHIBITOR FUNCTION

Facility

$30.00

Service Code	CPT 83520
Hospital Charge Code	900912844
Hospital Revenue Code	302
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$18.00
Rate for Payer: Aetna of CA Government/Medicare	$18.00
Rate for Payer: Cash Price	$30.00
Rate for Payer: Cash Price	$30.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$24.00
Rate for Payer: Health Smart Auto/Commercial	$18.00
Rate for Payer: Intervalley Health Plan Commercial	$17.27
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$18.00
Rate for Payer: LLUH Dept of Risk Management WC	$16.50
Rate for Payer: Multiplan Commercial	$22.50

HC SOM CA 27.29

Facility

$14.75

Service Code	CPT 86300
Hospital Charge Code	900911430
Hospital Revenue Code	302
Min. Negotiated Rate	$8.11
Max. Negotiated Rate	$20.81
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$8.85
Rate for Payer: Aetna of CA Government/Medicare	$8.85
Rate for Payer: Cash Price	$14.75
Rate for Payer: Cash Price	$14.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$11.80
Rate for Payer: Health Smart Auto/Commercial	$8.85
Rate for Payer: Intervalley Health Plan Commercial	$20.81
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$8.85
Rate for Payer: LLUH Dept of Risk Management WC	$8.11
Rate for Payer: Multiplan Commercial	$11.06

HC SOM CA 27.29

Facility

$14.75

Service Code	CPT 86300
Hospital Charge Code	900911430
Hospital Revenue Code	302
Min. Negotiated Rate	$8.11
Max. Negotiated Rate	$11.80
Rate for Payer: Cash Price	$14.75
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$11.80
Rate for Payer: Health Smart Auto/Commercial	$8.85
Rate for Payer: LLUH Dept of Risk Management WC	$8.11
Rate for Payer: Multiplan Commercial	$11.06

HC SOM CADMIUM WHOLE BLOOD

Facility

$30.00

Service Code	CPT 82300
Hospital Charge Code	900911051
Hospital Revenue Code	301
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$24.00
Rate for Payer: Cash Price	$30.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$24.00
Rate for Payer: Health Smart Auto/Commercial	$18.00
Rate for Payer: LLUH Dept of Risk Management WC	$16.50
Rate for Payer: Multiplan Commercial	$22.50

HC SOM CADMIUM WHOLE BLOOD

Facility

$30.00

Service Code	CPT 82300
Hospital Charge Code	900911051
Hospital Revenue Code	301
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$18.00
Rate for Payer: Aetna of CA Government/Medicare	$18.00
Rate for Payer: Cash Price	$30.00
Rate for Payer: Cash Price	$30.00
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$24.00
Rate for Payer: Health Smart Auto/Commercial	$18.00
Rate for Payer: Intervalley Health Plan Commercial	$23.64
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$18.00
Rate for Payer: LLUH Dept of Risk Management WC	$16.50
Rate for Payer: Multiplan Commercial	$22.50

HC SOM CAH 11-DESOXYCORTISOL

Facility

$76.96

Service Code	CPT 82634
Hospital Charge Code	900912775
Hospital Revenue Code	301
Min. Negotiated Rate	$42.33
Max. Negotiated Rate	$61.57
Rate for Payer: Cash Price	$76.96
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$61.57
Rate for Payer: Health Smart Auto/Commercial	$46.18
Rate for Payer: LLUH Dept of Risk Management WC	$42.33
Rate for Payer: Multiplan Commercial	$57.72

HC SOM CAH 11-DESOXYCORTISOL

Facility

$76.96

Service Code	CPT 82634
Hospital Charge Code	900912775
Hospital Revenue Code	301
Min. Negotiated Rate	$29.28
Max. Negotiated Rate	$61.57
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$46.18
Rate for Payer: Aetna of CA Government/Medicare	$46.18
Rate for Payer: Cash Price	$76.96
Rate for Payer: Cash Price	$76.96
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$61.57
Rate for Payer: Health Smart Auto/Commercial	$46.18
Rate for Payer: Intervalley Health Plan Commercial	$29.28
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$46.18
Rate for Payer: LLUH Dept of Risk Management WC	$42.33
Rate for Payer: Multiplan Commercial	$57.72

HC SOM CAH 17-ALPHA-OH PROGESTERONE

Facility

$71.41

Service Code	CPT 83498
Hospital Charge Code	900912778
Hospital Revenue Code	301
Min. Negotiated Rate	$39.28
Max. Negotiated Rate	$57.13
Rate for Payer: Cash Price	$71.41
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$57.13
Rate for Payer: Health Smart Auto/Commercial	$42.85
Rate for Payer: LLUH Dept of Risk Management WC	$39.28
Rate for Payer: Multiplan Commercial	$53.56

HC SOM CAH 17-ALPHA-OH PROGESTERONE

Facility

$71.41

Service Code	CPT 83498
Hospital Charge Code	900912778
Hospital Revenue Code	301
Min. Negotiated Rate	$27.17
Max. Negotiated Rate	$57.13
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$42.85
Rate for Payer: Aetna of CA Government/Medicare	$42.85
Rate for Payer: Cash Price	$71.41
Rate for Payer: Cash Price	$71.41
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$57.13
Rate for Payer: Health Smart Auto/Commercial	$42.85
Rate for Payer: Intervalley Health Plan Commercial	$27.17
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$42.85
Rate for Payer: LLUH Dept of Risk Management WC	$39.28
Rate for Payer: Multiplan Commercial	$53.56

HC SOM CAH 17-OH PREGNENOLONE

Facility

$59.95

Service Code	CPT 84143
Hospital Charge Code	900912776
Hospital Revenue Code	301
Min. Negotiated Rate	$22.81
Max. Negotiated Rate	$47.96
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$35.97
Rate for Payer: Aetna of CA Government/Medicare	$35.97
Rate for Payer: Cash Price	$59.95
Rate for Payer: Cash Price	$59.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$47.96
Rate for Payer: Health Smart Auto/Commercial	$35.97
Rate for Payer: Intervalley Health Plan Commercial	$22.81
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$35.97
Rate for Payer: LLUH Dept of Risk Management WC	$32.97
Rate for Payer: Multiplan Commercial	$44.96

HC SOM CAH 17-OH PREGNENOLONE

Facility

$59.95

Service Code	CPT 84143
Hospital Charge Code	900912776
Hospital Revenue Code	301
Min. Negotiated Rate	$32.97
Max. Negotiated Rate	$47.96
Rate for Payer: Cash Price	$59.95
Rate for Payer: Evernorth Behavioral Health (Cigna Behavioral Health) - HMO HMO/PPO	$47.96
Rate for Payer: Health Smart Auto/Commercial	$35.97
Rate for Payer: LLUH Dept of Risk Management WC	$32.97
Rate for Payer: Multiplan Commercial	$44.96

Know your out-of-pocket cost for care.

All Charges